title: Co-management between hospitalist and hepatologist improves the quality of care of inpatients with chronic liver disease.
abstract: OBJECTIVE
  Our institution shifted the care of patients with chronic liver disease (CLD) from Internal Medicine faculty, house staff, and consulting hepatology service to a co-managed unit staffed by academic hospitalists and hepatologists. The effect of co-management between hospitalists and hepatologists on the care of patients hospitalized with complications of CLD such as spontaneous bacterial peritonitis (SBP) is unknown.
  
  
  METHODS
  A retrospective chart review of 56 adult patients admitted with CLD and SBP from July 1, 2004 to June 30, 2010 was performed. Adherence rates to current management guidelines were measured along with costs and outcomes of care.
  
  
  RESULTS
  Patients admitted under the 2 models of care were similar; however, they consistently underwent paracentesis within 24 hours (100% vs. 79%, P=0.013), had appropriate avoidance of fresh-frozen plasma use (75% vs. 43%, P=0.05), received albumin (97% vs. 65%, P=0.002), and were discharged on SBP prophylaxis (91% vs. 37%, P<0.001) under the co-managed model compared with the conventional model. Costs of care were similar between the 2 groups. We note a trend toward improved outcomes of care under the co-management model as measured by transfer rates to the intensive care unit, inpatient mortality, 30-day readmission, and mortality rates.
  
  
  CONCLUSIONS
  These results support co-management between hospitalists and hepatologists as a superior model of care for hospitalized patients with SBP. Furthermore, this study adds to the growing literature indicating that efforts are needed to improve the quality of care delivered to CLD patients.
authors.affiliation: *Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine §Section of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, Department of Medicine ∥Section of Hospital Medicine, University of Chicago Medicine, Chicago, IL †Georgetown University Medical Center, Georgetown Transplant Institute, Washington, DC ‡Section of Hospital Medicine, North Shore University Health System, Evanston, IL.
authors.forename: Archita P
authors.initials: AP
authors.lastname: Desai
authors.forename: Rohit
authors.initials: R
authors.lastname: Satoskar
authors.forename: Anoop
authors.initials: A
authors.lastname: Appannagari
authors.forename: K Gautham
authors.initials: KG
authors.lastname: Reddy
authors.forename: Helen S
authors.initials: HS
authors.lastname: Te
authors.forename: Nancy
authors.initials: N
authors.lastname: Reau
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
authors.forename: Donald
authors.initials: D
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003299:Cooperative Behavior; D005260:Female; D019983:Guideline Adherence; D017721:Hospital Costs; D020445:Hospitalists / Q000458:organization & administration*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008107:Liver Diseases / Q000150:complications / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome